Invasive vulvar squamous cell carcinoma and chronic psoriasis

Abstract

Vulvar carcinoma is the fourth most common gynecologic malignancy[1]. A 50 year old patient presented to us for evaluation of an infiltrated, ulcerated vulvar tumour mass, with irregular borders, localized on the left labia majora. Also, palms, soles and elbows presented typical psoriasis plaques .
 The biopsy of the palmar tegument was concludent for vulgar psoriasis. The incisional vulvar biopsy revealed a squamous cell carcinoma. HPV testing was positive for HPV 16 infection with high-oncogenic risk. The CT scan showed the tumour located on the left labia majora, measuring 3 cm, with irregular borders and inguinal left node metastasis.
 The surgical treatment was partial vulvectomy with bilateral inguinal lymphadenectomy. The postoperatory course was good, with no local complications. Postoperative histological examination result was invasive squamous cell carcinoma, poorly differentiated(G3), basaloid, infiltrative(>1 mm, pT1b), with lymph node, ganglionar metastasis and capsular invasion(N2a). The surgical treatment was recommended to be followed by chemotherapy and radiotherapy.
 Our case highlights the aggresive, rapidly evolution of a squamocelular vulvar carcinoma in a patient with concomitantly chronic psoriasis. Psoriasis is a disease that alters the immune system and increases overall inflammation, which can expand the risk of developing cancers.. There is a high risk for malignancy in psoriatic patients [2]. A study found a higher frequency of all malignity among the patients with psoriasis; also, the risk of nonmelanoma skin cancer was higher [3].